Saeng-Fah Graham leads De Lune's community education initiatives. She is a Menstrual Doula with a passion for empowering humans through knowledge of their menstrual cycles.
Courtney Mayszak, RDN, LDN is De Lune's Lead Dietitian, overseeing clinical research and product development. She is a Registered Dietitian Nutritionist and a graduate of Cornell University.
SF: Let us start at the beginning. How did you get involved with De Lune?
CM: De Lune was a happy thing that just fell in my lap. Kai and Mimi—two of De Lune’s founders—are friends of mine from Cornell. We all lived in the same kooky fine arts dorm. When they were first designing the De Lune tincture, they reached out to me for my thoughts on which nutrients to include. I was immediately taken with the project and eventually came on board as an official team member.
SF: How would you describe your role at De Lune?
CM: I’m De Lune’s Registered Dietitian Nutritionist, and I’m involved everything we do related to science and nutrition. Specifically, I play a big role in research and development.
I spend a lot of time reading scientific literature, looking for natural solutions that are be effective at managing menstrual issues. Then I use those studies to formulate products. It’s really a dream! I'm also involving in translating the science in a way that everyone can understand. You can check out the De Lune Journal to read some articles I've written.
SF: Your title at De Lune is 'Lead Dietitian'. What’s the difference between a dietitian and a nutritionist?
CM: The term 'dietitian' is standardized, meaning every dietitian that you talk to has undergone a similar educational background, has passed an exam to become a dietitian, and will probably provide similar, evidence-based advice. The term 'nutritionist' isn’t standardized, so it’s a bit of a mixed bag. Some nutritionists have a PhD in nutrition, others may just really like nutrition and choose to identify as a nutritionist. So, all dietitians are nutritionists, but not all nutritionists are dietitians.
Dietitians refer to themselves as a Registered Dietitian (RD) or a Registered Dietitian Nutritionist (RDN). I often include 'nutritionist' in my title because when I would tell people I’m a dietitian, they’d often say “I’m not looking for a dietitian, I need a nutritionist,” and I’d have to respond, “I’m that, too!”.
SF: How did you become interested in nutrition? Why is it important to you?
CM: I think my interest in nutrition has a lot to do with how I was raised. I grew up in a middle-class, Midwestern home. My parents both worked and my younger brother has special needs, so my parents often found themselves short on time and energy to cook. Like many American families, my family ate the way of the Standard American Diet. We ate plenty of processed food, convenience food, frozen food, fast food, canned food, just-add-water-mix-and-bake food. While I had always known that healthy eating was important, it wasn’t until later in life that I realized the food I grew up eating was very different from the food I should be eating.
As I became more interested in public health, it was so startling to hear how many people’s lives are touched by cardiovascular disease, type II diabetes, and cancer. These diseases kill more Americans than any other cause, and they all can be prevented with good food. It became obvious to me that the Standard American Diet is a real issue, and becoming a Registered Dietitian was an impactful career that I could pursue.
SF: Apart from a healthy diet, what role do supplements play in health and wellness?
CM: Generally speaking, food should come first, and we should think of supplements as a way of filling in nutritional gaps (with some exceptions). That said, supplements play an important role in many people’s lives—something I didn’t fully appreciate until I got my feet wet in the field and started talking to clients. Americans are robust users of supplements; more than half of Americans take them. And for good reason! Researchers have linked supplements to preventing or managing various conditions, such as omega-3s and cardiovascular disease, or probiotics and IBS. Supplements can be used to manage side effects from medication.
Right now, it's fashionable to remove entire food groups from the diet, so that’s definitely going to create some nutritional gaps that supplements can fill. And, of course, there are many people who are required to avoid nutrient-rich foods for a variety of legitimate reasons. But either way, supplements are important to the health of these people.
SF: What role does nutrition play in menstrual health?
CM: We have handfuls of studies that suggest certain nutrients do in fact play a role in period pain and PMS. Researchers think some nutrients, like magnesium and zinc, can be used as period pain treatment options, and low levels of some nutrients, like calcium and B6, might be an underlying cause of PMS. Researchers have also pointed out that diets high in sodium or carbohydrates may exacerbate period pain and PMS.
But the evidence isn’t robust enough for there to be any established nutrition protocol for menstrual issues. That takes hundreds of very large, high-quality studies. Also, there aren't enough researchers who study period pain, let alone how period pain relates to nutrition. That's why, at De Lune, we opted to work directly with these researchers to understand the future of menstrual science and ensure our products are using the latest available research. We also donate 10% of our profits back to menstrual research efforts that are sorely underfunded.
SF: For such a pervasive issue, why doesn't menstrual research warrant more attention?
CM: There many factors at play. One reason that period pain is insufficiently studied is that it’s not life-threatening. Sadly, the fact that it’s often debilitating and extremely common isn’t enough to make researchers rich and famous for finding a “cure”. Also, researchers don’t often look to nutrition when studying period pain because of the temporality of the issue. Nutrition has the reputation of reducing disease risk over years or decades (which is true for some diseases but not others). With period pain, people are looking for the quickest fix possible. This isn’t to say that nutrition doesn’t play a role in pain management. It just means that people often turn to fast-acting drugs instead.
SF: What’s your take on natural approaches to managing period pain, as opposed to pharmaceutical approaches?
CM: Pharmaceuticals certainly have their place in the world, and obviously have a huge public health benefit. Personally I favor a complementary approach—that is, using both natural and conventional approaches, where appropriate. This is largely because pharmaceuticals often have side effects. Some natural therapies do as well, but they are typically much more manageable than their drug counterparts.
For period pain, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)—things like Advil and ibuprofen—are the go-to treatment option. Many people think NSAIDs are harmless, just because they’re so widely used. But they do have some real side effects. High blood pressure and stomach upset come to mind, but a whole host of side effects are possible. The risk increases when used in higher doses and for a longer duration. Many women are popping ibuprofen several times a day for the week they’re on their period, for their entire reproductive life. That really adds up!
Menstruators deserve an alternative to NSAIDs, and before De Lune, that alternative didn’t exist. We also know that NSAIDs don’t actually work for about 18% of menstruators, so these people are forced to find an alternative that wasn't available.
SF: At De Lune, we're constantly working to expand our knowledge and understanding, even in our fields of expertise. Speaking of that practice, I understand you recently had revelation around birth control and nutrition?
CM: I did! This revelation happened as I was writing an article for our journal on Vitamin B6. I ran across some research noting that oral contraceptive users (people who take birth control pills) are at an increased risk of B6 deficiency. And my eyes lit up! When I dug further, I learned that oral contraceptives put users at risk of a bunch of nutrient deficiencies—not just B6 but also B2, B12, folic acid, zinc, and vitamin C. As a birth control user myself, this really hit home for me. I mean, I’m formally trained in nutrition, and I had no idea these risks existed. My gynecologist certainly didn’t communicate them to me when I was prescribed birth control.
SF: Unknowingly incurring nutritional deficiencies by taking birth control must have been frustrating for you to discover.
CM: It really was. And thinking back, I remember that I developed Raynaud's disease a few months after I began taking birth control pills. Raynaud’s is when your fingers and toes totally lose circulation when they get even a little bit cold. And as I was digging into nutrient deficiencies caused by birth control, I learned that Raynaud’s disease is associated with zinc deficiency—one of the nutrients that birth control users are at risk of being deficient in. When I had first developed issues with Raynaud’s, I talked to my primary care physician. I even talked to a podiatrist because I was losing feeling in my feet. No one mentioned that this could be nutritional, or that it could be related to birth control.
I had also taken some animal foods out of my diet around the time I started taking birth control. Animal foods like meat and dairy are our primary sources of zinc; we have a hard time getting them from other sources (an important fact I didn’t know at the time).
I’ve since mentioned my Raynaud’s issues to a number of female friends, and was really struck by how many were like “Oh yeah, that happens to me, too.” Since many people turn to birth control as a way of treating menstrual pain, it’s so important that birth control users are aware of these nutrient deficiency risks so they can manage them appropriately.
SF: How, if in any way have you used the knowledge and wisdom you have gained as you’ve worked in the making of De Lune in your daily life?
CM: De Lune’s taught me that I don’t have to accept my period pain. Before De Lune was in my life, I regarded my period pain as a normal part of my physiology. I thought, “This is the hand I was dealt as a woman,” and I was told to muscle through it. Now I know that just because period pain is common doesn’t mean it's normal, and it doesn't mean it should be dismissed as a non-issue. I owe it to myself to do whatever I can to feel as though I am not physically and mentally compromised during my period. I deserve to be able to perform at my best, whether or not I happen to be menstruating.
SF: What are your ideas on the period positive movement? Are you liking where it’s heading?
CM: I think it’s hugely important to de-taboo and de-catastrophize menstruation. I really respect De Lune and other menstrual health companies for starting more conversations about periods and vouching for the health of women and non-binary folks. Personally, I’m very interested in gender disparities in research and medical care, so the period positive movement really resonates with me.
In fact, I just finished a great book on the topic called “Doing Harm” by Maya Dusenbery. The author argues that from the dawn of modern medicine, there’s been a lack of knowledge about women's health, and a lack of trust in women when they report symptoms, especially pain-related symptoms. For decades, physicians and researchers were predominantly male. Women still tend to not be well represented in modern research, and research conclusions tend to ignore the physiological and hormonal differences between men and women. And due to unconscious biases, both male and female physicians tend to write off women's pain as psychosomatic, or all in their head. It's a real tragedy.
Recently, we interviewed Professor Payne, a menstrual health expert at UCLA. She noted that the pain in our head and the pain we physically feel are one and the same. Dusenbery’s book also describes the lose-lose situation women face when reporting pain in the clinic. If women show too much emotion—like if they cry or grimace when they describe how much pain they’re in—they get accused of acting overly dramatic. However, if women act very stoic, their doctors don’t believe their pain exists. Either way, women don’t get the treatment they deserve.
SF: What’s one thing you would say to someone with challenging periods who want to support themselves through nutrition?
CM: There are a number of nutrients that appear to be involved in period pain—you can find them in De Lune’s tincture. For those interested in making some diet changes, moving toward a plant-based diet is worth the effort. There’s mounting evidence that plant-based diets are very good at reducing inflammation—be it chronic inflammation or acute pain. We also know that plant-based diets tend to be of higher overall quality—and the higher the quality the diet, the less of the risk of period pain.
When I say plant-based, I don’t mean you must remove animal foods completely. Animal foods like lean meats, seafood, and dairy products can still be represented if you feel comfortable eating them. But overall, animal foods should be more supporting role in the diet than a main actor. Whole, minimally processed plant foods like fruits and vegetables, whole grains, legumes, nuts and seeds, and healthy oils should make up the bulk of what we eat.
SF: How can those who don’t menstruate support those who do?
CM: There are so many options out there to support menstruators. For one, tampons, pads, and menstrual cups can be made free. Also, non-menstruators can regard period pain as a legitimate health issue, and can accommodate people with period pain in the same way they’d accommodate people with any other health issue, like allowing for time off from work or school.
But before this can happen, periods must be de-stimagized so menstruators feel comfortable talking to their peers, parents, teachers, professors, and bosses about their period. And de-stimagizing periods is a group effort that involves everyone—menstruators and non-menstruators.